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Implications for the vascular surgeon with prolonged (3 to 89 days) intraaortic balloon pump counterpulsation
J D Manord1, C L Garrard, M R Mehra
1Department of Surgery, Ochsner Clinic, New Orleans, LA, USA.
Insights
Long-term intraaortic balloon pump (IABP) therapy is feasible for heart failure patients, with operative removal showing fewer complications than percutaneous removal. This study assesses IABP management and outcomes for extended use.
Area of Science:
- Cardiovascular Medicine
- Medical Devices
Background:
- Intraaortic balloon pumps (IABPs) are vital for treating heart failure.
- While effective for short-term use, the safety and complications of prolonged IABP therapy remain unclear.
Purpose of the Study:
- To evaluate the feasibility, management strategies, and complication rates associated with long-term intraaortic balloon pump (IABP) therapy.
Main Methods:
- A retrospective analysis of 50 consecutive patients who received IABP support for over 72 hours.
- Evaluation of IABP-related complications, duration of support, and patient outcomes.
Main Results:
- The average IABP support duration was 23.2 days, with 16 patients experiencing 21 complications (ischemic, infectious, hemorrhagic).
- Complication predictors included longer support duration, multiple IABP uses, and failed percutaneous insertions.
- Operative removal had a lower complication rate (0%) compared to percutaneous removal (14%).
Conclusions:
- Prolonged IABP therapy is feasible with an acceptable complication rate.
- Operative removal of IABPs is safer than percutaneous removal and recommended for extended therapy.
- No mandatory removal or site rotation is needed based solely on indwelling time.
Purpose:
The intraaortic balloon pump (IABP) is useful in the treatment of failing hearts. Although most experience with IABPs has been with acute short-term use, the safe duration of therapy and possible complications of long-term IABP use are uncertain. We evaluated the feasibility, management, and complications associated with long-term IABP therapy.
Methods:
Fifty consecutive patients with 87 IABPs were evaluated retrospectively. All patients had IABP support for greater than 72 hours. Results and complications were evaluated.
Results:
The mean duration of IABP support was 23.2 days. There were 21 IABP-related complications in 16 patients: (16 ischemic, three infections, two hemorrhage). The rate of complications was 0.13 per patient-week of support. Significant predictors of complications were total days of IABP support (p < 0.0001), use of multiple IABPs (p < 0.0001), and attempted but unsuccessful percutaneous insertions (p < 0.001). Complications led to 14 vascular procedures (five patch angioplasties, four bypass procedures, two major amputations, one fasciotomy, one groin exploration for hemorrhage, and one removal of an infected Dacron patch). Percutaneous removals had a 14% complication rate compared with none after operative removal (p = 0.02). Thirty-two patients survived (64%). Of the survivors, 27 underwent transplant.
Conclusions:
Prolonged IABP therapy is feasible and is associated with an acceptable rate of complications. Operative removal is superior to percutaneous removal. Percutaneous removal should be limited to short-term therapy. There is no need for mandatory removal or site rotation based solely on indwelling time.